Investigating the effects of contraceptive use on inflammation in the female genital tract

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dc.contributor.advisorRiou, Catherine
dc.contributor.advisorBunjun, Rubina
dc.contributor.advisorMasson, Lindi
dc.contributor.advisorDeese, Jennifer
dc.contributor.authorHarryparsad, Rushil
dc.date.accessioned2026-06-29T13:35:50Z
dc.date.available2026-06-29T13:35:50Z
dc.date.issued2026
dc.date.updated2026-06-29T13:24:58Z
dc.description.abstractHormonal contraceptives are used worldwide by women of reproductive age (15-49 years). Immune cells, cytokines and antimicrobial peptides play an important role in the protection of the female genital tract (FGT) against infections, including HIV and other sexually transmitted infections (STIs). Contraceptives are thought to cause biological changes in the FGT, possibly altering susceptibility to infection. This project aimed to investigate the biological changes caused by contraceptive use that may impact risk of HIV and STI acquisition. Clinical samples were collected from two hundred and thirty-two participants in three clinical trials: (1) Evidence for Contraceptive Options and HIV Outcomes (ECHO; South Africa); (2) Extended Duration of Sayana Press (Brazil); and (3) Lower Dose medroxyprogesterone acetate (MPA) Pharmacokinetic/Pharmacodynamic (Brazil and Dominican Republic) studies. STIs were assessed by multiplex polymerase chain reaction and reverse hybridisation, cervical CD4+ T cell frequencies by flow cytometry, vaginal cytokines by Luminex and antimicrobial peptides by enzyme-linked immunosorbent assay. In women randomized to levonorgestrel (LNG) implant, copper intrauterine device (copper-IUD) or depot medroxyprogesterone acetate (DMPA-IM; 150mg) in the ECHO trial, even though STI incidence was exceptionally high (107.9/100 wy), there were no significant differences in incidence between arms over three months following contraceptive initiation. Women randomized to DMPA-IM had a greater proportion of cervical 7+CD4+ T cells compared to copper-IUD. Those using LNG implant had an increased proportion of cervical β7+CD4+ T cells following contraceptive initiation and an increased proportion of Th17 cells compared to the copper IUD group. Copper IUD users had significantly higher concentrations of FGT human beta defensin (HBD)-1 and 2 compared to LNG implant and DMPA-IM users post contraceptive initiation. In the Lower Dose study, FGT interleukin (IL)-8 and HBD-1 concentrations were significantly lower three months post contraceptive initiation among women receiving 104mg or 105mg MPA compared to the pre-contraceptive follicular, but not luteal phase. No significant changes in immune mediators were observed in the Sayana Press study over a follow-up period of 12 months. The findings of this study contribute to growing knowledge of the effects of contraceptives on FGT immune factors that may influence susceptibility in infection.
dc.identifier.apacitationHarryparsad, R. (2026). <i>Investigating the effects of contraceptive use on inflammation in the female genital tract</i>. (). University of Cape Town ,Faculty of Health Sciences ,Department of Pathology. Retrieved from http://hdl.handle.net/11427/43413en_ZA
dc.identifier.chicagocitationHarryparsad, Rushil. <i>"Investigating the effects of contraceptive use on inflammation in the female genital tract."</i> ., University of Cape Town ,Faculty of Health Sciences ,Department of Pathology, 2026. http://hdl.handle.net/11427/43413en_ZA
dc.identifier.citationHarryparsad, R. 2026. Investigating the effects of contraceptive use on inflammation in the female genital tract. . University of Cape Town ,Faculty of Health Sciences ,Department of Pathology. http://hdl.handle.net/11427/43413en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Harryparsad, Rushil AB - Hormonal contraceptives are used worldwide by women of reproductive age (15-49 years). Immune cells, cytokines and antimicrobial peptides play an important role in the protection of the female genital tract (FGT) against infections, including HIV and other sexually transmitted infections (STIs). Contraceptives are thought to cause biological changes in the FGT, possibly altering susceptibility to infection. This project aimed to investigate the biological changes caused by contraceptive use that may impact risk of HIV and STI acquisition. Clinical samples were collected from two hundred and thirty-two participants in three clinical trials: (1) Evidence for Contraceptive Options and HIV Outcomes (ECHO; South Africa); (2) Extended Duration of Sayana Press (Brazil); and (3) Lower Dose medroxyprogesterone acetate (MPA) Pharmacokinetic/Pharmacodynamic (Brazil and Dominican Republic) studies. STIs were assessed by multiplex polymerase chain reaction and reverse hybridisation, cervical CD4+ T cell frequencies by flow cytometry, vaginal cytokines by Luminex and antimicrobial peptides by enzyme-linked immunosorbent assay. In women randomized to levonorgestrel (LNG) implant, copper intrauterine device (copper-IUD) or depot medroxyprogesterone acetate (DMPA-IM; 150mg) in the ECHO trial, even though STI incidence was exceptionally high (107.9/100 wy), there were no significant differences in incidence between arms over three months following contraceptive initiation. Women randomized to DMPA-IM had a greater proportion of cervical 7+CD4+ T cells compared to copper-IUD. Those using LNG implant had an increased proportion of cervical β7+CD4+ T cells following contraceptive initiation and an increased proportion of Th17 cells compared to the copper IUD group. Copper IUD users had significantly higher concentrations of FGT human beta defensin (HBD)-1 and 2 compared to LNG implant and DMPA-IM users post contraceptive initiation. In the Lower Dose study, FGT interleukin (IL)-8 and HBD-1 concentrations were significantly lower three months post contraceptive initiation among women receiving 104mg or 105mg MPA compared to the pre-contraceptive follicular, but not luteal phase. No significant changes in immune mediators were observed in the Sayana Press study over a follow-up period of 12 months. The findings of this study contribute to growing knowledge of the effects of contraceptives on FGT immune factors that may influence susceptibility in infection. DA - 2026 DB - OpenUCT DP - University of Cape Town KW - Hormonal contraceptives KW - female LK - https://open.uct.ac.za PB - University of Cape Town PY - 2026 T1 - Investigating the effects of contraceptive use on inflammation in the female genital tract TI - Investigating the effects of contraceptive use on inflammation in the female genital tract UR - http://hdl.handle.net/11427/43413 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/43413
dc.identifier.vancouvercitationHarryparsad R. Investigating the effects of contraceptive use on inflammation in the female genital tract. []. University of Cape Town ,Faculty of Health Sciences ,Department of Pathology, 2026 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/43413en_ZA
dc.language.isoen
dc.language.rfc3066eng
dc.publisher.departmentDepartment of Pathology
dc.publisher.facultyFaculty of Health Sciences
dc.publisher.institutionUniversity of Cape Town
dc.subjectHormonal contraceptives
dc.subjectfemale
dc.titleInvestigating the effects of contraceptive use on inflammation in the female genital tract
dc.typeThesis / Dissertation
dc.type.qualificationlevelDoctoral
dc.type.qualificationlevelPhD
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